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  5. Petra Diagnostics, Inc.

Petra Diagnostics, Inc.

Company Details

Name: Petra Diagnostics, Inc.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 15 Dec 2008 (16 years ago)
Identification Number: 000487917
ZIP code: 02818
County: Kent County
Principal Address: 63 CEDAR AVENUE SUITE 12, EAST GREENWICH, RI, 02818, USA
Purpose: OFFICES OF DENTISTS Title: 7-1.2-1701
NAICS: 621210 - Offices of Dentists

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1881827780 2009-08-26 2009-08-26 350 KINGSTOWN RD, SUITE 203, NARRAGANSETT, RI, 028823262, US 350 KINGSTOWN RD, SUITE 203, NARRAGANSETT, RI, 028823262, US

Contacts
Phone +1 401-284-3500
Fax 4012843502

Authorized person
Name LISA W. TYLER
Role PRESIDENT
Phone 4012950260

Taxonomy
Taxonomy Code 261QD0000X - Dental Clinic/Center
License Number 2494
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2022 264076835 2023-05-05 PETRA DIAGNOSTICS, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012646110
Plan sponsor’s address 63 CEDAR AVENUE, SUITE 12, EAST GREENWICH, RI, 02818
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2022 264076835 2023-10-25 PETRA DIAGNOSTICS, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012646110
Plan sponsor’s address 63 CEDAR AVENUE, SUITE 12, EAST GREENWICH, RI, 02818
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2021 264076835 2022-09-28 PETRA DIAGNOSTICS, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012646110
Plan sponsor’s address 63 CEDAR AVENUE, SUITE 12, EAST GREENWICH, RI, 02818
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2020 264076835 2021-10-12 PETRA DIAGNOSTICS, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012646110
Plan sponsor’s address 63 CEDAR AVENUE, SUITE 12, EAST GREENWICH, RI, 02818
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2019 264076835 2020-09-14 PETRA DIAGNOSTICS, INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012843500
Plan sponsor’s address 350 KINGSTOWN ROAD, SUITE 203, NARRAGANSETT, RI, 02882
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2018 264076835 2019-09-20 PETRA DIAGNOSTICS, INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012843500
Plan sponsor’s address 350 KINGSTOWN ROAD, SUITE 203, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2019-09-20
Name of individual signing LISA TYLER
Valid signature Filed with authorized/valid electronic signature
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2017 264076835 2018-07-06 PETRA DIAGNOSTICS, INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012843500
Plan sponsor’s address 350 KINGSTOWN ROAD, SUITE 203, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2018-07-06
Name of individual signing LISA TYLER
Valid signature Filed with authorized/valid electronic signature
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2016 264076835 2017-08-25 PETRA DIAGNOSTICS, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012843500
Plan sponsor’s address 350 KINGSTOWN ROAD, SUITE 203, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2017-08-25
Name of individual signing LISA TYLER
Valid signature Filed with authorized/valid electronic signature
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2015 264076835 2016-10-14 PETRA DIAGNOSTICS, INC. 2
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012843500
Plan sponsor’s address 350 KINGSTOWN ROAD, SUITE 203, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2016-10-14
Name of individual signing LISA TYLER
Valid signature Filed with authorized/valid electronic signature
PETRA DIAGNOSTICS, INC. 401(K) RETIREMENT PLAN 2014 264076835 2015-10-19 PETRA DIAGNOSTICS, INC. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012843500
Plan sponsor’s address 350 KINGSTOWN ROAD, SUITE 203, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2015-10-19
Name of individual signing LISA TYLER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/04/15/20140415145418P030347275057001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012843500
Plan sponsor’s address 350 KINGSTOWN ROAD, SUITE 203, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2014-04-15
Name of individual signing LISA TYLER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/23/20130723105729P040115606293001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Sponsor’s telephone number 4012843500
Plan sponsor’s address 350 KINGSTOWN ROAD, SUITE 203, NARRAGANSETT, RI, 02882

Signature of
Role Plan administrator
Date 2013-07-23
Name of individual signing LISA TYLER
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/05/09/20120509143012P030010769938001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2011-01-01
Business code 621210
Plan sponsor’s address 350 KINGSTOWN ROAD, SUITE 203, NARRAGANSETT, RI, 02882

Plan administrator’s name and address
Administrator’s EIN 264076835
Plan administrator’s name PETRA DIAGNOSTICS, INC.
Plan administrator’s address 350 KINGSTOWN ROAD, STE 203, SUITE 203, NARRAGANSETT, RI, 02882
Administrator’s telephone number 4012843500

Signature of
Role Plan administrator
Date 2012-05-09
Name of individual signing LISA TYLER
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
LISA W. TYLER, DMD Agent 63 CEDAR AVENUE SUITE 12, EAST GREENWICH, RI, 02818, USA

PRESIDENT

Name Role Address
LISA W TYLER DMD PRESIDENT 215 WICKFORD POINT ROAD NORTH KINGSTOWN, RI 02852 USA

Filings

Number Name File Date
202451506870 Annual Report 2024-04-18
202335357060 Annual Report 2023-05-07
202212991110 Statement of Change of Registered/Resident Agent Office 2022-03-16
202212974410 Annual Report 2022-03-16
202191208810 Annual Report 2021-02-14
202033027490 Annual Report 2020-01-26
201983774500 Annual Report 2019-01-04
201856423900 Annual Report 2018-01-20
201729635580 Annual Report 2017-01-06
201690052250 Annual Report 2016-01-05

Related by officers

No related officers

Related by address

63 CEDAR AVENUE SUITE 12, EAST GREENWICH, RI, 02818, USA

Greenwich Bay Financial Services, Inc. GREENWICH BAY PROPERTIES, LLC

Date of last update: 13 Oct 2024

Sources: Rhode Island Department of State

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